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Because of their rich blood supply and of their original detersive and filling properties, the muscular pedicled flaps harvested from the trunk or the omental flap elevated from the abdomen may be very usefull to treat large defects or major septic problems in pleural, pericardic or mediastinal cavities. We here describe the main principles to be followed in such intrathoracic reconstructions performed in order to control severe mediastinites, aortic prosthetic infections, pleural empyemas and broncho-pleural, tracheo-esophageal or broncho-esophageal fistulas. In all these circumstances, the muscular or omental flaps which are transferred into the chest are selected according to the recipient field and to their respective access to the upper, middle and lower portions of the pleural space or mediastinum. Twelve different flaps so appear available to achieve the adequate reconstruction, filling or coverage of nine distinct topographic sites. Their rational use, based on various anatomical guidelines, allows to prevent or to cure efficiently 90% of the infectious or fistular complications frequently observed in the postoperative course of aggressive, functional or oncological, intrathoracic surgical procedures.

On July 13, 1994, at the "Cliniques universities St. Luc", a wearable left ventricular assist device was successfully implanted, for the first time in Belgium, in a 44-year-old male. He had been readmitted with end-stage congestive heart failure 7 years after a first cardiac transplantation. In the absence of a suitable donor heart, the Novacor system was installed: the prosthetic ventricle is buried in the left flank and connected to the apex of the left ventricle and to the ascending aorta by means of valved conduits. The Novacor has allowed the patient to be optimally revalidated while waiting for a "ideal" donor heart. On Oct.-16, 1994, after 95 days of assistance, re-transplantation was uneventful and the patient has resumed a full-ranged activity as from January 1995.